EyeWorld Asia-Pacific December 2021 Issue

CORNEA EWAP DECEMBER 2021 33 by Ellen Stodola Editorial Co-Director COVID-19 impact on eye banking and corneal donor tissue Contact information Aldave: aldave@jsei.ucla.edu Khandelwal: Sumitra.Khandelwal@bcm.edu Mian: smian@med.umich.edu T he COVID-19 pandemic has had an impact on the screening and use of corneal donor tissue for corneal transplants. Shahzad Mian, MD, Sumitra Khandelwal, MD, and Anthony Aldave, MD, discussed evolving regulations, tissue eligible for use, and more. "ne of the first people to identify that COVID-19 was spreading in China was an ophthalmologist. This ophthalmologist was exposed to COVID-19 while managing an asymptomatic patient with glaucoma, became infected with the virus, and died from it, Dr. Mian said. There was concern that there was direct spread from touching the eye, which led to concern about the eye being a vector for transmission of SARS-CoV-2. It also caused concern for corneal transplants. Infection is always a concern for organ and tissue donation, Dr. Khandelwal said. The Eye Bank Association of America (EBAA) provided several guidelines for ocular tissue recovery. Although testing of the donor for SARS-CoV-2 is not required, a thorough review of the medical chart is conducted and tissue from suspect cases (even if COVID-19 is negative on patient testing) is reviewed by the medical director. There is not much research on the prevalence in ocular tissue because the recommendation is not to recover from donors with confirmed or suspected COVID-19 for the safety of staff, Dr. Khandelwal added, noting that there has been some lab research on SARS-CoV-2 found in ocular tissue. The decision was made that anyone who died from COVID-19 could not be a donor for corneal tissue, Dr. Mian said. “That has been in place from the beginning, and this has evolved to include that anyone who was exposed to COVID within the last month is not a candidate to be a donor,” he said. There are also criteria relating to if the potential donor was symptomatic. “There was a lot of attention paid to building a system that reduces the risk for recipients,” Dr. Mian said. “Having said that, we don’t actually know if it can be transmitted if someone gets a corneal transplant from a donor who had COVID-19. Though there have been some cases when a recipient has inadvertently gotten donor tissue where the donor was positive for COVID-19, no one has gotten COVID-19 from a transplant that we know of. “Because we have these certain criteria where we don’t even take tissue from donors who had COVID-19, we’re only looking at donors who could potentially have been asymptomatic and then tested positive,” Dr. Mian said. Looking carefully at data for donors, he said that among those donors who are asymptomatic but tested positive, there is about a 15 % risk of having ocular involvement. Similarly, those who were symptomatic but tested negative showed about a 15% chance of having COVID-19 in their eyes. In a study Dr. Mian participated in, 1 investigators found a 13 % rate of COVID-19 positivity among potential donors. Then they looked at donors who had exposure but didn’t have any symptoms. “In our study, we found that none of them were positive for COVID-19.” They also looked at the overall donor pool to identify donors who were thought to be fine asymptomatic] either not tested or tested early on and were negative). When retested, about 4 % were positive for COVID-19. It is possible even to miss some cases when you have criteria for ruling tissue out, he added. Dr. Mian reiterated that there haÛe not Leen any confirmed cases of someone getting the virus from a cornea whose donor was COVID-19 positive. Since the beginning of the pandemic, the EBAA has worked to establish detailed criteria This article originally appeared in the September 2021 issue of EyeWorld . It has Leen slightlÞ modified and appears here with permission from the ASCRS Ophthalmic Services Corp.